Case Presentation 19

1. Alameda County EMS Case Presentation #19 Jim Pointer, M.D., FACEP Medical Director Alameda County EMS

2. Alameda County EMS The Call • You respond to a 9-1-1 call on a busy suburban street for “traumatic injury.” Your patient, a seven year-old male, is lying prone on the street with his head nodding in confusion. An electric microscooter lies on its side in the middle of the street.

3. Alameda County EMS Initial Assessment • ABCs: • Airway – open • Breathing – labored • Circulation – no bleeding • Glasgow - 9: • Eyes – 2 • Verbal – 3 • Motor – 4

4. Alameda County EMS Focused H & P • On lookers state the patient attempted to avoid a car, swerved and fell, striking his head and “legs.” • Child was wearing no safety equipment and was traveling about 10 mph on the wrong side of the street. • No other history available and the parents are at work.

5. Alameda County EMS Pertinent Findings • Vital Signs: • B/P – 80/50 • RR – 32 • HR – 145 • Pulse Ox – 96% • Young male obviously seriously injured

6. Alameda County EMS Pertinent Findings (cont.) • HEENT: • Head – large abrasion left fronto-temporal area • Ears – no blood from ears • Eyes – pupils 4 mm, slightly sluggish, reactive • Nose – WNL • Teeth – WNL • Neck – no obvious injuries, unable to assess pain or tenderness

7. Alameda County EMS Pertinent Findings (cont.) • Chest and abdomen: no significant trauma • Pelvis: stable • Extremities: deformity left lower leg, distal pulses intact • Neuro: GCS – 9 • Patient does not answer questions but is seen to move all four extremities • Skin: cool and moist

8. Alameda County EMS Initial Treatment • Attempts at intubation unsuccessful • Non-rebreather mask - 100% O2 • Two large bore IVs started • Spinal immobilization • Left lower leg splinted • Transported to Children’s Hospital

9. Alameda County EMS

10. Alameda County EMS Hospital Findings • Young, white male in acute distress • Vital signs: B/P – 120/82, RR – 40, HR – 142, Pulse Ox – 98% on O2 • Physical findings essential the same as yours

11. Alameda County EMS Lab Studies • CBC: WBC – 17.2 K, H & H – 15.3 / 47.2 • Chemistries, glucose, urinalysis: WNL • X-rays: Spinal, chest, pelvic and Left lower leg • Plain CT of the head • Hospital staff can not find the parents

12. Alameda County EMS CT Scan

13. Alameda County EMS Extremity X-Ray

14. Alameda County EMS Hospital Outcome • Patient taken to OR for evacuation of subdural hematoma • Open reduction, internal fixation (ORIF) of the tibial fracture • Discharged eight days later on crutches with case, neurologically intact!

15. Alameda County EMS Addendum • Parents were cited by local police for allowing a child under 16 to operate a motorized scooter and for failure to provide safety equipment.

16. Alameda County EMS Discussion • Skateboard and scooter injuries: • Skateboards • 56,000 ED visits • 1,900 hospitalized • Scooters (all) • 15,800 ED visits • 90% of all injuries occur in kids < 15 years old. Source: American Academy of Pediatrics

17. Alameda County EMS Skateboard Injuries • 87% - male • Distribution of Injuries: • 74% - extremities • 21% - head & neck • 5% - trunk • Injuries occur more frequently in the younger child Source: US Consumer Product Safety Committee

18. Alameda County EMS Skateboard Injuries (cont.) • Most common Injuries: • Wrist fractures • Ankle sprains • Face lacerations • Lower arm fractures • Wrist sprains Source: US Consumer Product Safety Committee

19. Alameda County EMS Motorized Scooters • Rising in popularity • Gasoline or battery powered • Cost: $200 - $1500 • Cost of protective gear: $35 • Gas models against the law in many jurisdictions • Many areas have restrictions • California’s age is 16 • US CPSC issued warning in 2001 • Parents poor judgment a major factor in injuries.

20. Alameda County EMS Motorized Scooter Injuries • 39% are kids < 15 years old • At least three deaths associated with motorized scooters • 6 year old boy who fell off • 11 year old boy who crashed with a truck • 46 year old man who was struck by a car • Fractures the most common injury • Over 5000 injuries requiring ED treatment in 2002

21. Alameda County EMS SCOOTER SAFETY

22. Alameda County EMS Injury PreventionSkateboards & Scooters • Never ride in the street • Never ride at night • Obey all traffic laws

23. Don’t take chances Complicated tricks require careful practice and a specially designed area Only one person per skateboard Never hitch a ride from a car, bus, truck or bicycle Alameda County EMS Injury Prevention (cont.)

24. Alameda County EMS Injury Prevention (cont.) • Learn how to fall – it may help reduce serious injury • Losing balance – crouch down so you won’t have as far to fall • If you fall – • try to land on “fleshy” parts of your body • try to roll rather than absorb the force with your arms • try to relax your body rather than stiffen

25. Alameda County EMS Injury Prevention (cont.) • Use Safety equipment! • helmet • Slip resistant shoes • Padding (knee, elbow and wrist guards) • Children < 5 should not use skateboards or scooters • Children < 16 should not ride motorized scooters

26. Alameda County EMS California Law • January 1, 2000: • Children under 16 prohibited from operating motorized vehicles, including scooters, and requiring helmet. • January 1, 2003: • Bicycle helmet law expanded to require children under 18 to wear safety equipment when riding scooters, skateboards or skating

27. Alameda County EMS EMS Helmet & Bicycle Safety Brochure Alameda County Emergency Medical Services Agency Helmet & Bicycle Safety Program (510) 618-2050